Catheterizing endoscope



Jan 23, 3953 J.- s. CHASE CATHETERIZING ENDOSCOPE Filed April 20, 1956.1A/VENTO.

United States The invention described herein may be manufactured andused by or for the Government for governmental purposes without thepayment of any royalty thereon.

The present invention relates to endoscopic instruments for theinspection and catheterization of body cavities and more particularly toan improved type of catheterizing endoscope embodying an improved meansfor the manipulation and control of its catheter. Still moreparticularly the present invention provides certain improvements in theconstruction of a catheterizing bronchoscope wherein there are embodiedimprovements enabling a catheter tube and illuminating telescope to beinserted into the pulmonary bronchae of an individual to illuminate andfacilitate bronchoscopic exploration and treatment thereof.

Itis a general object of the invention to provide a means for directlymanually controlling, manipulating, and guiding a catheter employed incombination with an endoscopic instrument.

Another object of the invention is to provide a greatly simplified meansfor directing and controlling a catheter used in conjunction with anendoscope which does not require lthe employment of complex and bulkyequipment with the endoscope in order to obtain a wide range or eld ofcatheter control operation.

Another object of the invention is to provide a bron- ,choscopeembodying a catheter, an illuminated telescope, and means forcontrolling and directing the position of the catheter within thebronchial tree of a patient without increasing the total size orcomplexity of the bronchoscope.

A further object of the invention is to provide a catheterizingendoscope embodying a means integral with its distal end to guide,direct, and deflect the end portions of the catheter at a desired anglefrom the body of the endoscope, the means also partially surrounding thecatheter to hold it in the desired position relative to the body of theendoscope and to maintain it in its relative position with the body ofthe endoscope when the endoscope is rotated or displaced upward ordownward by handle means attached to its viewing end, thus obviating thenecessity of removing and reinserting the catheter each time the scopeis moved in relation to the cavity or bronchus being examined.

A still further object of the invention lies in providing an assembly ofan illuminating telescope, endoscope, and exible catheter in which theproblem of quickly and e'iciently guiding the catheter into the iield ofvision and desired point of operation is accomplished by means oi asimple structure and design integral with the distal end of theendoscope, and making possible direct, trouble-free, manual manipulationand control of the catheter Within a body cavity or bronchial tree.

Broadly described, the endoscope having the aforementioned featuresincorporates an elongated tube provided with a plurality of passagesincluding a large central passage and a catheterizing passage whichcontains a ilexatent ZZLiQ Patented Jan. 28, 1958 ible catheter tube.The distal end of the elongated tube is angled to permit easy insertionand the obtaining of a larger iield of observation, and is provided withmeans adjacent to the distal opening of the catheter containing passageto engage, deflect, and direct the catheter to a desired location foroperation and at a selected angle with the elongated tube.

Further objects and a more thorough understanding of the invention maybe obtained by reference to the following description and claims takenin conjunction with the accompanying drawings which disclose anillustrative embodiment of the construction forming the basis of theinvention and in which- Fig. l is a plan View of one embodiment of thecatheterizing endoscope illustrated as a bronchoscope;

Fig. 2 is a side elevation of the bronchoscope;

Fig. 3 is a detailed plan View of the distal end of the bronchoscopeshowing the arrangement of the catheter in the guide means, theilluminating telescope being depicted in broken lines;

Fig. 4 is a longitudinal section taken along the line 4 4 of Fig. 3;

Fig. 5 is a horizontal section taken along the line 5 5 of Fig. 3;

Fig. 6 is a vertical section taken along the line 6--6 of Fig. 3; and vFig. 7 is a vertical section taken along the line 7- of Fig. 4.

In accordance with the invention, endoscopic means are provided forinsertion into a body cavity to permit its inspection andcatheterization. ln the present preferred embodiment of the invention,such means cornprises an elongated tube assembly or scope 3 (Figs. l and2) having a plurality of passages to provide means for the quick andeiiicient insertion and withdrawal of various instruments into thecavity of the body which is to be examined, treated, or catheterized.

As embodied, said scope S (Figs. l and 2) comprises a large central tubeit), an evacuation tube 12, parallel to and extending along the largecentral tube, and a catheter-enclosing tube i4 also parallel to andextending along the central tube but on a diametrically opposite side ofthe central tube from the evacuation tube l2.. The evacuation andcatheter-enclosing tubes i2 and i4 have walls integral with the wall ofthe central tube 10; how-ever, tbe passages formed by the evacuation andcatheterenclosing tubes l2 and 14 are completely separate and distinctfrom the passage formed by the central tube i0 except that they arejoined to it by openings (to be described below) at the distal end ofthe scope 8. A handle 16 is mounted on the viewing end of the scope 8 toprovide holding means both for insertion of the scope into a body cavityand for rotation, displacement, and translation of the scope afterinsertion. Formed air openings 20 are provided in the side wall of thecentral tube l0 to permit that tube to serve as a breathing as Well as aWorking passage.

The distal end of the scope 8 is angled and provided with built-upsmooth rounded edges in order to permit easy insertion of the scope intoa body cavity and a Wide iield of observation after insertion (Fig. 3).In operation of the scope S, an illuminating telescope 22 is insertedthrough the central tube 1i! until it projects into the cavity to beexamined; the central tube 10 of the scope 8 and the telescope 22. areconstructed so that clearance is provided between the wall of the tube10 and the telescope suicient to permit the tube l0 to continue tofunction as a breathing passage after the telescope has been inserted.The illuminating telescope 22 comprises a right angle viewing telescopehaving an objective 24 at its distal end and an illuminating lightsource 26-immediately adjacent to the objective. The evacuation tube 12is connected to the central tube 10 at its distal end through a port 2S,and the catheter enclosing tube 14 terminates by an opening 30 into thecentral tube at a point slightly above the extreme distal end of thecentral tube 10 but low enough in the large tube that the opening 3b isvisible when the angled end of the scope is viewed from above. Acatheter 31 is inserted in the catheter enclosing tube 14 after thescope 8 has been inserted in the body cavity until the inserted end ofthe catheter 31 protrudes through the opening 30 (Fig. 3). signed foruse as a bronchoscope, the evacuation tube 12 includes an extension 18at the viewing end to which a vacuum pump may be attached for theremoval of edematose liquid from the lung cavity by drawing it throughthe port 28 and up the evacuation tube 14 to prevent interference withvision and manipulation of the catheter 31. Should it be necessary tosupply oxygen to the patient being examined, an oxygen source can beattached to the extension 18 of the evacuation tube 12.

ln conformance with the invention, means are provided to permit accuratecontrol, manipulation, direction, and guidance of the catheter 31 to anydesired location in the body cavity being examined. kin the illustratedpreferred embodiment of the invention, such means comprise a speciallyformed guide which partially surrounds the catheter 31, holds it at aselected angle of deiiection with the scope S, and permits guidance ofthe end portions of the catheter over a wide range within the bodycavity by rotation and displacement of the scope relative to the bodycavity and direct manual manipulation of the catheter 31 from theviewing end of the scope.

As embodied, said means for guiding, directing, and holding the catheter31 comprise an arcuate rounded channel 32 integral with and formed fromthe inside surface of the distal end of the scope 8. The channel 32extends from immediately below the opening 3), continues downward andtoward one side of the distal end of the scope S, and terminates at oneside of and slightly above the tip 34 of the distal end of the scope.The said means also comprise a guide lip 36 extending along the lengthof the arcuate channel 32 on the side of the channel nearest to thecentral axis of the scope 8. Thus, the guide lip 36 partially enclosesthe arcuate channel 32 to a degree sufiicient to encompass a portion ofthe circumference of the catheter 31 which after emerging at the opening30, is held firmly in. place and directed along the arcuate channel 32by the guide lip 36 which folds partially around it. The arcuate channel32 is designed and constructed so that it will hold the catheter 31 atthe selected angle of deection with the body of the scope S to place theend portion of the catheter 31 within the illuminated held of thetelescope 22.

In operation, the scope 8 is inserted into the body cavity which is tobe examined, treated, or catheterized, and the catheter 31 is insertedinto the catheter-enclosing tube 14 until its end portion emerges at theopening 39 and extends slightly beyond the arcuate channel 32. The rightangle illuminating telescope is inserted in the central tube 10 eitherbefore or after insertion of the catheter 31. After the telescope 22 andcatheter 31 have both been inserted in the scope S they are mutuallyadjusted until the tip of the catheter may be seen in the illuminatefield of view of the telescope. While observing the por- Y tion ot thebody cavity to be catheterized, the operator may position the scope 8 byits handle 16 to rotate, translate, or displace it until the catheter 31is generally aimed at the desired location. The catheter 31 may then hedirected to the spot selected for application with ease by eitherinserting or retracting it in the catheter-enclosing tube i4 andsimultaneously mailing any necessary adjustments in the position of ythescope S by means of the handle 16.

Thus, the present invention provides a catheterizing endoscope havingspecially designed means which con- When dei serves space, is simple inconstruction, trouble-free in operation, and permits extremely accurateand positive control, guidance, and direction of the catheter.

lt is obvious that changes in the details of the embodiment describedand illustrated for the purpose of explaining the nature of the presentinvention may be made by those skilled in the art without departing fromthe spirit and scope of the invention as expressed in the appendedclaims. It is therefore intended that these details be interpreted asillustrative, and not in a limiting sense.

Having thus described my invention and illustrated its use, what I claimas new and desire to secure by Letters Patent is:

l. An instrument for inspecting and catheterizing body cavities adaptedto be used with a combination telescope and lighting tube, saidinstrument comprising a formed elongated longitudinal tube having aplurality of passages including a large central passage and a pair ofsmall passages parallel to and positioned on the outer wall of and ondiametrically opposite sides of the central passage, the elongated tubehaving a viewing end and a distal end, the distal end being angled forfacilitating insertion of the assembly and observation within a bodycavity, a flexible catheter tube inserted through one of the smallpassages and extending beyond its distal end, an arcuate channel locatedat the termination of the catheter-.containing passage and formed in thedistal end of the central tube to guide the catheter to one side of thetube, and a projecting lip integral with and partially surrounding thearcuate channel to hold the catheter in place, the arcuate channel andprojecting lip acting to effect adesired angular deflection of the endportion of the catheter extending beyond the distal end of the tube tohold it Within the confines of the arcuate channel, and to guide it in adesired direction.

2. An instrument for examining and catheterizing body cavitiescomprising a sheath having a plurality of passageways including aworking passageway, an evacuation passageway, and a catheterizingpassageway; the sheath having a viewing end and a distal end, the distalend of the sheath including an angled fenestra and embodying a tip atits lowest point, means for providing illuminated vision through thecentral passageway coextensive with the range of vision outside thefenestra, a ilexible catheter inserted through the catheterizingpassageway, the catheterizing passageway having an .opening into theworking passageway above the tip of the distal end of the sheath, anarcuate rounded channel integral with and formed from the inner wall ofthe working passageway, the channel commencing at the opening of thecatheterizing passageway and curving to its termination at the side ofthe working passageway slightly above the tip of the distal end of thesheath, a rounded flange forming a partial continuation of thecatheterizing passageway and integrally attached to and coextensive withone side of the arcuate channel, the ange engaging and holding thecatheter to guide it and deect it out of the enestra and into theilluminated field of vision.

3. An endoscopic instrument for inspecting and catheterizing bodycavities adapted to be used with a combination telescope and lightingtube, said instrument comprising an elongated central tube forming aworking passage, an evacuation tube parallel to and integrally extendingalong the central tube, a catheter-containing tube parallel to andintegrally extending along the central tube opposite from the evacuationtube, the resulting tube assembly hav.- ing a viewing end and a distalend, the distal end having an angled taper and tip for facilitatinginsertion of the assembly into a body cavity, a flexible catheterinserted through the catheter-containing tube, the catheter-containingtube having an opening into the central tube above the tip of the distalend of the tube assembly, a curved groove in the inner wall of thecentral tube extending downward from the opening of thecatheter-containing tube curving away from the longitudinal axis andtoward one side of the tube assembly and terminating slightly above thetip of the distal end, a curved protuberance forming a partialcontinuation of the catheter-containing tube integral with the curvedgroove and the inner wall of the central tube on the side of the grooveadjacent to the longitudinal axis of the assembly to partially enfoldthe catheter and hold its end portion at a selected angle of deflectionwith the tube assembly whereby the end portion of the catheterprojecting and extending beyond the distal end of the tube assembly maybe guided and directed to an exact location in the cavity beingexamined.

4. A bronchoscopic instrument for examining and catheterizing lungcavities comprising an elongated central tube forming a working andbreathing passage, a second tube forming an evacuation and oxygenpassage parallel to and integrally extending along the central tube, athird tube forming a catheterizing passage parallel to and integrallyextending along the central tube opposite from the second tube, theresulting tube assembly having a viewing end and a distal end, a handleattached at the viewing end, the distal end having an oblique fenestraand embodying a tip at its extremity, an illuminating telescope slidablyextending through the central tube and commanding a field of visioncoextensive With the range of vision outside the fenestra, the secondtube having a port adjacent to its lower end and connecting it to thecentral tube, the third tube having an opening into the central tubeabove the tip of the distal end on the unfenestrated side of the tube, aexible catheter inserted in the third tube, a curved groove integrallyformed in the wall of the central tube extending laterally in a curvefrom the opening of the third tube to the edge of the central tubeimmediately above the tip ofthe distal end, and a built up projectinglip extending along the lower side of the curved groove to partiallyencompass the catheter and hold it in the curved groove.

References Cited in the file of this patent UNITED STATES PATENTS2,112,056 Wappler Mar. 22, 1938 2,120,996 Wappler June 21, 19382,129,391 Wappler Sept. 6, 1938 2,243,992 Wappler June 3, 1941

